RN Nurse Auditor

Eisenhower Medical Center; United States; On-site; USD 66,248 - 107,700; Full time

Job summary

Eisenhower Medical Center in the United States seeks a Medical Records Auditor within Patient Financial Services. The role audits demographic data and clinical documentation, pre-audits charts for insurer reviews, and leads process improvement efforts.

You will present findings to the Hospital Chart Audit Committee and Compliance Officer. Qualifications include a nursing degree and California RN licensure; prior auditing and customer service experience are preferred.

Qualifications

• Bachelor’s degree in Nursing or Master’s degree in Nursing, or active RN degree track.
• California RN Licensure required.
• Experienced Medical Auditor with knowledge of Medical Records and coding.
• Prior Customer Service experience preferred.

Responsibilities

• Demonstrates compliance with Code of Conduct and policies; reports concerns.
• Coordinates audit scheduling with external auditors and departments.
• Meets with external auditors and conducts exit conferences.
• Reports patterns of poor documentation to Compliance committees.
• Prepares monthly audit reports with charges, deficiencies and determinations.
• Attends seminars on compliance, billing and chart review.

Skills

MS Word

Excel

Database applications

Verbal communication

Written communication

Cost center charging practices

Medical terminology

Education

Bachelor’s degree in Nursing

RN Licensure (California)

Job description

Overview

Sign On Bonus Eligible. Default Work Shift: Day (United States of America). Hours: 40. Salary range: $48.09 - $78.18. Schedule: Full Time. Shift Hours: 8 Hour. Department: Patient Financial Services.
Job Objective: Responsible for concurrent audits of Medical Record Chart for verification of consistent demographic data and completeness of clinical documentation; responsible for pre‑auditing medical records for all accounts scheduled for audits by insurance companies, external audit agencies and/or patient requested audits. Responsible for instituting and leading Process Improvement Teams to record, quantify and correct deficiencies. Represents PFS to share audit findings with the exiting Hospital Chart Audit Committee and Hospital Compliance Officer and Committee.

Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Coordinates medical record audit scheduling with external auditors, medical records and ancillary departments when necessary.
• Meets with external auditors during scheduled audits and assists as needed.
• Conducts exit conference with external auditors.
• Reports to Compliance Officer and Compliance Committee any patterns seen relative to poor documentation or charting.
• Reports any charging issues that do not conform to current Federal Regulations governing billable/non‑billable charges.
• Prepares monthly reports showing total patient/defense and concurrent audits for the month with total gross charges, over‑charges/under‑charges by department, defense results, and final determination; summarizes deficiencies found in medical record charts including itemization of issues, current status of correction activities.
• Attends available seminars pertaining to compliance issues and guidelines, medical and billable coding, and medical record charting.
• Provides positive indication that teamwork is a major and important focus of all Eisenhower Medical Center employees.
• Conducts periodic in‑service classes for ancillary departments instructing staff on charge/chart review.
• Conducts periodic in‑service classes for Patient Financial Services department instructing staff on common medical terms and errors in charging.
• Performs other job‑related duties as requested by Supervisor.
• Attends staff meetings, in‑house training and attends classes pertaining to Federal and State billing regulations as well as compliance issues and guidelines when requested.

Qualifications

• Bachelor’s degree in Nursing or Master’s degree in Nursing, or enrollment in an RN‑Bachelor’s degree in Nursing or RN‑Master’s degree in Nursing program within one year of hire and completion within five years of hire if hired after July 1, 2012.
• California RN Licensure.
• Experienced Medical Auditor with knowledge of Medical Records and coding.
• Prior Customer Service experience is preferred.

Skills, Knowledge & Abilities

• Effective computer knowledge of MS Word, Excel and database applications.
• Excellent verbal and written communication skills; ability to make executive presentations.
• Experience with hospital cost center charging practices, knowledge of hospital billing and database systems.
• Familiar with billing and medical records compliance issues as mandated through Federal regulations.
• Must understand commercial and managed care patient accounting principles.
• Proficient understanding of medical terminology, managed care terminology, and CPT/ICD9 coding.